“Many people will not be able to see the physicians who have treated them for years, use facilities providing the most appropriate treatment, or access care within a reasonable time and distance from their homes.”

by
JONATHAN M. METSCH, DR.P.H., LLCHudson Reporter

Aug 07, 2014 | 841 views | 0 | 3 | |

Don’t assume that you can continue to see your doctor….

A recent City Journal article http://www.city-journal.org * noted that “… having health insurance is not the same thing as getting good health care, or any health care. In fact, it doesn’t matter how many Americans obtain insurance under the ACA. Most will have difficulty finding a physician.”

“Those who do get coverage through the exchanges and pay their premiums will also struggle to get medical care. The ACA requires insurers to accept every patient regardless of risk, provide expansive benefits packages, and eliminate caps on lifetime benefits. Looking to control costs, most insurers are offering exchange plans that severely limit the number of doctors and hospitals patients can visit. Some state exchanges—including New York’s—don’t offer a single plan that covers visits to out-of-network doctors or hospitals.”

“If this scenario sounds familiar, it’s because we’ve seen it before, during the failed managed-care experiment of the 1990s. Patients and physicians quickly became disenchanted with the restrictions and bureaucratic complexity of Health Maintenance Organizations (HMOs). At least patients had options then. They could avoid HMO restrictions by buying broader, more expensive insurance plans. Many plans available now on the state exchanges are highly restrictive, HMO-like networks.”

“Patient choice has been further compromised by the haphazard implementation of the exchanges. Patients have reported trouble determining which physicians will participate in which plans. Doctors, too, are often unaware whether they’re listed in particular insurance networks and what the reimbursement rates are. Many find themselves arbitrarily excluded from plans in which they had previously participated; others are getting listed on plans without their knowledge.”

*to read the full City Journal article “The Doctor Won’t See You Now” by Joel Zinberg, highlight and click on open hyperlink http://www.city-journal.org/2014/eon0414jz.html